Thursday, September 07, 2006

Whiplash can have lesionsNikolai BogdukIntroduction: Pain in childrenG Allen FinleyChildren’s self-reports of pain intensity: Scale selection, limitations and interpretationCarl L von Baeyer Self-report measures, such as faces scales, visual analogue scales and numerical scales, are often underutilized in assessing children’s pain. They can be used in conjunction with observer reports of pain and can provide a valuable indication of treatment outcome in both clinical and research contexts, although interpretation may be complex. Desirable features of pediatric pain intensity scales are outlined, and several instruments are recommended for clinical use.Ensuring pain relief for children at the end of lifeMarie-Claude Grégoire, Gerri Frager Pediatric palliative care is defined as the active and total approach to care, embracing physical, psychological and spiritual elements, focusing on enhancement of quality of life for the child and support for the family. It is not limited to end-of-life or terminal care but rather has a broader, more inclusive approach and integrates palliative care concurrently with curative-oriented goals. This article focuses on the management of pain at the end of life, which may extend from days to months. The understanding necessary within the team to ensure excellence when caring for infants, children and adolescents at the end of life is highlighted.Innovative approaches to neuraxial blockade in children: The introduction of epidural nerve root stimulation and ultrasound guidance for epidural catheter placementBan CH Tsui Pediatric epidural anesthesia has many benefits when used for perioperative analgesia, although techniques to ensure precise catheter placement are crucial. Maximum therapeutic potential with minimal medication dosage is important with pediatric patients. Innovative techniques for guiding and confirming placement of catheters include electrical epidural stimulation and bedside ultrasound. This article provides a brief and focused review of these techniques and highlights the relevant clinical experiences to date.A survey of the pain experienced by males and females with Fabry diseaseAndrea L Gibas, Regan Klatt, Jack Johnson, Joe TR Clarke, Joel Katz Fabry disease is a rare, multisystemic disease marked by neuropathic pain. Males reportedly suffer extensively, whereas females are asymptomatic or mildly afflicted. However, in this study, Fabry disease pain produced comparable distress and impairment in both sexes. Additionally, females were diagnosed later in life than were males, and unlike males, they did not exhibit a decline in pain intensity with disease duration. Satisfaction with physician pain assessments was moderate, although to a lesser degree for female patients. Fabry disease females may be triply disadvantaged in the health care system due to devalued carrier status, sex and disease rarity.Infrared therapy for chronic low back pain: A randomized, controlled trialGeorge D Gale, Peter J Rothbart, Ye Li The objective of the present study was to assess the degree of pain relief obtained by applying infrared (IR) energy to the low back in patients with chronic, intractable low back pain. Forty patients with chronic low back pain of over six years’ duration were recruited from patients attending the Rothbart Pain Management Clinic, North York, Ontario. They came from the patient lists of three physicians at the clinic, and were randomly assigned to IR therapy or placebo treatment. The principle measure of outcome was pain rated on the numerical rating scale (NRS). The pain was assessed overall, then rotating and bending in different directions. The mean NRS scores in the treatment group fell showed a greater reduction than the NRS scores of the placebo group. It was concluded that the IR therapy unit used was effective in reducing chronic low back pain, and no adverse effects were observed.Whiplash injuries can be visible by functional magnetic resonance imagingBengt H Johansson Whiplash trauma can result in injuries that are difficult to diagnose. Diagnosis is particularly difficult in injuries to the upper segments of the cervical spine (craniocervical joint complex). Studies indicate that injuries in that region may be responsible for the cervicoencephalic syndrome with headache, balance problems, vertigo, dizziness, eye problems, tinnitus, poor concentration, sensitivity to light and pronounced fatigue. Consequently, diagnosis of lesions in the craniocervical joint complex region is important. Functional magnetic resonance imaging is a radiological technique that can visualize injuries of the ligaments and the joist capsules, and accompanying pathological movement patterns.